Text Size

-

+

reset

The truth is, nobody has a good, real-time fix on how successful the Affordable Care Act has been in reducing the ranks of the uninsured. The Obama administration hasn’t been able to say how many of the 3.3 million people who have signed up for private health insurance coverage, or of the 6.3 million who have been determined eligible for Medicaid, were actually uninsured before — and health care experts aren’t sure yet, either.

There have been a couple of surveys, and at least one state — New York — has been keeping track of how many people were uninsured when they applied for coverage. But their answers are so wildly different that all we can say is, it’s either a tiny minority that were uninsured, or it’s most of them.

Want to narrow that down? You’ll just have to wait. We might have some better hints in April — but it could be next year before there are national numbers that everyone will accept.

The search for real, trustworthy numbers shows just how hard it is to track how many uninsured people are gaining health coverage in anything close to real time, and even harder to link those changes directly to the ACA. Unless you’ve got a reliable way of gathering that information when people sign up — which hasn’t been in place during the Obamacare enrollment season — you pretty much have to wait until a think tank does a national survey, or even until the census figures come out next year.

It all adds up to frustration for supporters, opponents and everyone else who’s trying to track the progress of Obamacare — because reducing the ranks of the uninsured was, well, kind of the point.

“It’s going to take some time,” said Edwin Park, vice president for health policy at the liberal Center on Budget and Policy Priorities. “I know everyone wants to know, ‘X percent was uninsured,’ but what we know so far is mostly anecdotal, and it’s probably not accurately capturing what’s going on.”

There have been some early signs of success. The Obama administration has reported, and the Census Bureau has confirmed, that the uninsured rate for young adults has already dropped, most likely because the law lets young adults up to age 26 stay on their parents’ plans. The administration estimates that 3 million young adults have gained coverage that way.

But if the Congressional Budget Office is right, the drop in the uninsured rate over the next few years should be much bigger and easily measurable. In its latest estimates, CBO predicted that the number of uninsured Americans would drop by a total of 13 million this year — including private health insurance and coverage through Medicaid and the Children’s Health Insurance Program — and by 25 million in 2016.

The way things are going, though, it could be a long time before we know whether CBO was even close to the mark.

The administration could have helped by putting a specific question on the applications for the federal health insurance exchange, and encouraging all of the state-run exchanges to do the same, that would have allowed the government to track how many people were uninsured when they signed up.

The problem is, the questions they did put on the federal applications aren’t specific enough to be reliable — which is why administration officials say they can’t answer questions yet about how much progress it has actually made on the uninsured.

The questions are worded differently on the online and paper applications, but in both cases, they just ask the customers whether they need health coverage. That’s not exactly the same as asking if they’re uninsured, because they might have a health insurance plan that’s about to end, or need new health coverage for other reasons. And it’s an optional question, so the government can’t be sure everyone is answering it.

Aaron Albright, a spokesman for the Centers for Medicare & Medicaid Services, says the administration is “currently evaluating if additional data may be needed to accurately answer this question, and we hope to have this data in the future.”

Part of the complication, of course, is that enrollment season isn’t over — people can keep signing up through March 31. Many health care analysts are expecting a final wave of enrollments toward the end, which could boost the numbers of uninsured people who get coverage, especially among those who weren’t in any hurry to sign up. And even then, it will take time to know how many people are actually enrolled, since not everyone who signs up will pay their premiums.